CT-guided 125I brachytherapy for hepatocellular carcinoma in high-risk locations after transarterial chemoembolization combined with microwave ablation: a propensity score-matched study

Chen, Zixiong; Fu, Xiaobo; Qiu, Zhenkang; Mu, Maoyuan; Jiang, Weiwei; Wang, Guisong; Zhong, Zhihui; Qi, Han; Gao, Fei

doi:10.2478/raon-2023-0012

Figures & Tables

Patient flow diagram.
TACE = transarterial chemoembolization; MWA = microwave ablation — Patient flow diagram. TACE = transarterial chemoembolization; MWA = microwave ablation

Kaplan-Meier curves comparing progression-free survival (PFS) and overall survival overall survival (OS) from different groups. (A) Cumulative PFS between the unmatched A and B groups. (B) Cumulative PFS between the matched A and B groups. (C) Cumulative OS between the unmatched A and B groups. (D) Cumulative OS between the matched A and B groups.

Kaplan-Meier curves comparing progression-free survival (PFS) and overall survival (OS) according to the statistically significant prognostic factors in the multivariate analysis after propensity score-match. (A) Cumulative PFS between portal vein tumor thrombosis (PVTT) and None-PVTT patients. (B). Cumulative OS between male and female. (C) Cumulative OS between Barcelona clinic liver cancer (BCLC) B and C stages patients.

Subgroup analyses revealed by Kaplan-Meier curves comparing progression-free survival (PFS). (A) Comparison of the PFS between portal vein tumor thrombosis (PVTT) and None-PVTT patients in group B. (B) Comparison of the PFS between PVTT and None-PVTT patients in group A. (C) Comparison of the PFS between group A and B in patients with PVTT. (D) Comparison of the PFS between group A and B in none-PVTT patients. (E) Comparison of the PFS between group A and B in high-risk location 1. (F) Comparison of the PFS between group A and B in high-risk location 2.

Complications related to the procedure

Adverse events	Group A (N = 49)	AE Grade			Group B (N = 98)	AE Grade			P value
Adverse events	Group A (N = 49)	1	2	3-4	Group B (N = 98)	1	2	3-4	P value
Fever	3	3	0	0	3	9	10	0	0.608‡
Nausea	5	3	2	0	5	9	11	0	0.852†
Diarrhea	3	2	1	0	3	5	5	0	1‡
Pain required treatment	13	10	3	0	13	39	42	0	0.007†*
Liver abscess	0	0	0	0	0	1	1	0	1‡
Puncture hemorrhage	1	1	0	0	1	5	8	0	0.274‡
Displacement of seeds	0	0	0	0	0	-	-	-	-
RILD	0	0	0	0	0	-	-	-	-

Intrahepatic and high-risk locations tumor responses in the two groups after propensity score matching (PSM)

Tumor response	Intrahepatic Tumor			Tumor in high-risk locations

	Group A (n = 49)	Group B (n = 98)	P value	Group A (n = 49)	Group B (n = 98)	P value
Complete response (CR)	4	6		5	9
Partial response (PR)	21	23		28	29
Stable disease (SD)	17	41		13	40
Progressive disease (PD)	7	28		3	20
Objective response rate (ORR) (%)	51.0%	29.6%	0.011†*	67.3%	38.8%	< 0.001†*
Disease control rate (DCR) (%)	85.7%	71.4%	0.055†	93.9%	79.6%	0.025†*

Baseline patient characteristics before and after propensity score-matched

Parameter	Total (N = 181)	Total cohort			PSM cohort

		Group A	Group B	P	Group A	Group B	P

		N = 49	N = 132	value	N = 49	N = 98	value
Sex				0.37			0.751
Male	162 (89.5%)	46 (93.9%)	116 (87.9%)		46 (93.9%)	89 (90.8%)
Female	19 (10.5%)	3 (6.12%)	16 (12.1%)		3 (6.12%)	9 (9.18%)
Age (y)	56.0 [47.0;64.0]	56.0 [47.0;68.0]	55.5 [48.0;62.0]	0.425	56.0 [47.0;68.0]	55.0 [48.0;62.0]	0.468
BCLC				0.041*			1
B	72 (39.8%)	13 (26.5%)	59 (44.7%)		13 (26.5%)	26 (26.5%)
C	109 (60.2%)	36 (73.5%)	73 (55.3%)		36 (73.5%)	72 (73.5%)
Maximum median (IQR), tumor mm diameter,	29.0 [18.0;49.0]	36.0 [22.0;53.0]	26.5 [18.0;46.0]	0.039*	36.0 [22.0;53.0]	31.0 [18.0;57.8]	0.579
Tumor number				0.927			0.66
1-2	60 (33.1%)	17 (34.7%)	43 (32.6%)		17 (34.7%)	29 (29.6%)
≥ 3	121 (66.9%)	32 (65.3%)	89 (67.4%)		32 (65.3%)	69 (70.4%)
PVTT				0.202			1
None	108 (59.7%)	25 (51.0%)	83 (62.9%)		25 (51.0%)	49 (50.0%)
Yes	73 (40.3%)	24 (49.0%)	49 (37.1%)		24 (49.0%)	49 (50.0%)
Distant metastasis				0.171			0.953
None	109 (60.2%)	25 (51.0%)	84 (63.6%)		25 (51.0%)	52 (53.1%)
Yes	72 (39.8%)	24 (49.0%)	48 (36.4%)		24 (49.0%)	46 (46.9%)
High risk location				0.045*			0.76
1	98 (54.2%)	33 (67.3%)	65 (49.2%)		33 (67.3%)	62 (63.3%)
2	83 (45.8%)	16 (32.7%)	67 (50.8%)		16 (32.7%)	36 (36.7%)
TACE sessions	2.00 [1.00;3.00]	2.00 [1.00;2.00]	2.00 [1.00;3.00]	0.442	2.00 [1.00;2.00]	1.00 [1.00;3.00]	0.464
MWA sessions	1.00 [0.00;2.00]	1.00 [0.00;2.00]	1.00 [0.00;2.00]	0.162	1.00 [0.00;2.00]	1.00 [0.00;2.00]	0.31
Cause of liver disease:				0.09			0.181
Continued
HCV/HBV	169 (93.4%)	43 (87.8%)	126 (95.5%)		43 (87.8%)	93 (94.9%)
Other	12 (6.6%)	6 (12.2%)	6 (4.55%)		6 (12.2%)	5 (5.10%)
ECOG score				0.189			0.669
0	126 (69.6%)	30 (61.2%)	96 (72.7%)		30 (61.2%)	65 (66.3%)
1	55 (30.4%)	19 (38.8%)	36 (27.3%)		19 (38.8%)	33 (33.7%)
Child-pugh score				0.563			0.386
A	82 (45.3%)	46 (93.9%)	36 (27.3%)		46 (93.9%)	86 (87.8%)
B	99 (54.7%)	3 (6.12%)	96 (72.7%)		3 (6.12%)	12 (12.2%)
AFP, ng/mL				0.811			0.576
< 400	125 (69.1%)	35 (71.4%)	90 (68.2%)		35 (71.4%)	64 (65.3%)
≥ 400	56 (30.9%)	14 (28.6%)	42 (31.8%)		14 (28.6%)	34 (34.7%)
PT (s)	12.2 [11.5;13.1]	12.0 [11.5;12.8]	12.3 [11.6;13.1]	0.167	12.0 [11.5;12.8]	12.2 [11.5;13.1]	0.331
ALB (g/L)	40.35 [36.2;43.9]	40.8 [36.7;44.1]	40.2 [36.0;43.9]	0.329	40.8 [36.7;44.1]	40.3 [36.1;44.1]	0.518
TBIL (mg/dL)	13.55 [10.1;19.32]	12.3 [8.73;18.2]	14.6 [10.4;20.4]	0.167	12.3 [8.73;18.2]	14.6 [10.1;20.2]	0.227

Multivariate analyses of predictors of progression-free survival after treatment

Risk Factor	Univariate			Multivariate

	HR	95%CI	P value	HR	95%CI	P value
Sex
Female	1
Male	0.755	0.393–1.451	0.399
Age (y)
< 60	1
≥ 60	1.093	0.761–1.569	0.63
Maximum diameter (tumor mm)	1.006	1.000–1.013	0.071*	1.003	0.996-1.010	0.458
Tumor number
1-2	1
≥ 3	1.104	0.915–1.332	0.302
BCLC stage
B	1
C	1.395	0.929–2.095	0.109
High-risk location
1	1
2	0.665	0.456–0.970	0.034**	0.846	0.550-1.302	0.447
PVTT
None
Yes	1.615	1.124–2.319	0.010**	1.625	1.015-2.546	0.040**
Distant metastasis
None
Yes	1.099	0.772–1.565	0.602
TACE sessions	1.062	0.964–1.170	0.223
MWA sessions	1.006	0.914–1.106	0.905
Treatment
TACE+MWA	1
TACE+MWA+ ¹²⁵I	0.527	0.357–0.778	0.002**	0.479	0.328-0.733	<0.001**
Cause of liver disease
Other	1
HBV/HCV	1.36	0.662–2.791	0.402
ECOG score
0	1
1	1.269	0.876–1.837	0.208
AFP
≤ 400 ng/mL	1
Continued
> 400 ng/mL	1.72	1.164–2.542	0.006**	1.403	0.948-2.129	0.090
Prothrombin time (s)	0.942	0.827–1.073	0.367
Albumin (g/L)	0.987	0.951–1.024	0.477
Continued
Total Bilirubin (μmol/L)	1.001	0.995–1.008	0.649
Child-pugh class
A	1
B	1.216	0.654–2.263	0.536

CT-guided 125I brachytherapy for hepatocellular carcinoma in high-risk locations after transarterial chemoembolization combined with microwave ablation: a propensity score-matched study

Figures & Tables

Figure 1

Figure 2

Figure 3

Figure 4

Complications related to the procedure

Intrahepatic and high-risk locations tumor responses in the two groups after propensity score matching (PSM)

Baseline patient characteristics before and after propensity score-matched

Multivariate analyses of predictors of progression-free survival after treatment

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